Michigan Sales And Use Tax Certificate Of Exemption - City Of Flint printable pdf download

Michigan Department of Treasury

Form 3372 (Rev. 11-09)

Michigan Sales and Use Tax Certificate of Exemption

DO NOT send to the Department of Treasury. Certificate must be retained in the Seller’s Records. This

certificate

is invalid unless all four sections

are completed by the purchaser.

SECTION 1: TYPE OF PURCHASE

One-time purchase.

Blanket

certificate.

Order or Invoice Number:

Expiration Date (maximum of four years):

March 6, 2016

Blanket Certificate. Recurring business relationship

The purchaser hereby claims exemption on the purchase of tangible personal property and selected services made from the vendor listed below. This

certifies that this claim

based upon the purchasers proposed use of the items or services, OR the status of the purchaser.

Vendors Name and Address

SECTION 2: ITEMS COVERED BY THIS CERTIFICATE

Check one of the following:

All items purchased

Limited to the following items:

SECTION 3: BASIS FOR EXEMPTION CLAIM

Check one of the following:

For Resale at Retail. Enter Sales Tax License Number:

________________________

For Lease. Enter Use Tax Registration Number:________________________________

The following exemptions DO NOT require the purchaser to provide a number:

For Resale at wholesale

Agricultural Production. Enter percentage:

Industrial Processing. Enter percentage:

Church, Government Entity, Nonprofit School, or Nonprofit Hospital (Circle type of organization)

Nonprofit Internal Revenue Code Section 501 (c)(3) or 501 (c)(4) Exempt Organization (must provide IRS authorized letter with this form)

Nonprofit Organization with an authorized letter issued by the Michigan Department of Treasury prior to June 1994 (must provide copy of

letter with this form)

Rolling Stock purchased by an Interstate Motor Carrier

io.D Other (explain):

SECTION 4: CERTIFICATION

I declare,

under penalty of perjury,

that the

information on

this

certificate is true,

that!

have consulted

the

statutes, administrative rules

and

other

sources of

law applicable

to my exemption,

and that!

have exercised reasonable care in assuring

that

claim

of exemption is

valid

under

Michigan

law. In the event

this

claim is

disallowed, I

full

responsibility for

the

payment of tax, penalty

and

any accrued interest, including,

necessary,

reimbursement to

the

vendor for tax

and

accrued interest,

Type of Business (see codes on page 2)

Business Name

Municipal Government

City of Flint

Business Address

City, State, ZIP Code

1 101 South

Saginaw Street

Flint, Ml 48502

Business Telephone Number (include area code)

Name (Print or Type)

(810) 7667266

Gerald

Ambrose, Finance Director

Signa/

Date gned

Michigan Sales And Use Tax Certificate Of Exemption - City Of Flint

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